Gateway Health Assessments Liz Court

Overview GATEWAY HEALTH ASSESSMENT SERVICE: Who are we Who do we see Why do this What do we do How have we done so far.. PURPOSE Joint agency approach to identify the health and education needs of children and young people who come to the attention of Child youth and Family CYF Enable children and young people to access services that best meet their needs Health assessment and education assessment and ISA and 3 month follow up education assessment is prior ( allows triangulation of info /reliability of info) so we have report from SW/school/parent/ caregiver

Janine Friend ( Nurse Coordinator 1.0 FTE) Who are we ? : MDT Janine Friend ( Nurse Coordinator 1.0 FTE) Drs Donna Woolerton and Sneha Sadani (1.0 FTE) Liz Court and Andrea McOnie Perfect (Psychologists 1.0 FTE ) Jill Love (Administrator 1.0) We work in two teams covering 4 clinical days per week Attempt to see a family all on one day 2 clinicians (MDT approach) Paediatric/medical review and Psychological screening MSD contract for the Waikato DHB: 475 assessments a year Volumes: 10 clinic appointment a week : 2 hours per child

Aims of WAIKIDS Gateway Health Assessments are to: What do we do ? Aims of WAIKIDS Gateway Health Assessments are to: identify “health” needs (broad view: physical, spiritual/cultural, psychological and mental health) identify the interventions/supports that help child/family best meet those needs develop an agreement between agencies on who will take responsibility for organising ,funding and facilitating the recommendations

Referrals from CYF social workers only Who do we see ? Referrals from CYF social workers only All children and young people entering care Children and young people already in care when it will help clarify and identify ways to address their needs Children and young people who are being referred for a care and protection FGC where a gateway assessment would help identify their needs Estimates nationally :coming into care 2,200 per year section 78,101,102,110(2)a,139,140 In care 500 per year Fgc 1,500

The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego. More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made. Why do this ? ACE study references The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego. More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made. Adverse Childhood Experiences (ACE) http://acestudy.org/ http://www.cdc.gov/ace

Gateway pilot projects NZ: 2008 2010 MOH and MOE Gateway population are by definition complex families often with long history of involvement with services (ACE score >4 plus plus). Pilots across four district health boards – Auckland, Counties Manukau, Lakes, and Mid Central, alongside 16 Child, Youth and Family sites.  Three or more health needs per child were identified as a result of the assessments.  Information from the pilots is consistent with international research, and showed that of the children and young people who came into CYF care: 65 % have mental health or behavioural problems 40 % of these are likely to need specialist services (historically only around 7% received specialist mental health services) 15 % developmental delay 37 % have impaired hearing Around 40 % need dental care, help with skin conditions or hearing issues. http://www.cyf.govt.nz/keeping-kids-safe/ways-we-work-with-families/gateway-health-and-education-assessments.html#Resourcesforparentsandcaregivers5 Hand out ACE q

Why psychology input into a medical screen ?? Gateway population complex families often with long history of involvement with services. Gateway Pilots projects have found consistently high percentage of clients with emotional or behavioural difficulties (65%) and mental health disorder (41%). These children require at least secondary level assessments and use of specialised assessment tools (ie ‘more’ than primary health screening tools) and analysis. Pilot projects found referral to mental health /counselling services the most difficult, partly due to clients not meeting entry criteria for existing resources. Psychological input allows for more seamless access by providing the more detailed assessments to inform referrals to mental health, developmental and NGO counselling services.

Gateway Assessment process Social worker: referral, CYF file review and consent from guardian (this is usually the birth parents). Initiates request for education review. Gateway Coordinator : sends info requests and arranges appointment Psych and Paed : ‘Health’ assessment and referrals Coordinator: Interagency Service Agreement (ISA) MDT meeting Follow-up in 3 months (Review) Social worker: completes plan and monitors Education profiles (preschool, RTLB, SENCO and SDQ) Information requests ACC NGO DHB’s Well Child Provider NZ Health info service GP

The Assessment process cont.. 2 hours assessment per child Combined assessment with Psychologist and Paediatrician : Physical, Psychological, Developmental in the wider context of the child Ideally parents; current caregivers and social worker must attend with the child. Care and protection and developmental history, school history and current academic functioning, medical history and health check , mental health and trauma screening interviews and use of psychometric standardised tools , HEADSS tool, review of current placement : issues that may impact on well being FORMULATION : Presentation and the 4 P’s :Protective, Predisposing, Precipitating, Perpetuating factors

How have we done so far? Findings: Multiple placements Safety issues March 2012 to present: 535 referrals 435 assessments completed 57% MALE 75%PLUS Maori Findings: Multiple placements Safety issues Consent privacy issues Developmental delays/poor exec functioning/language development Health problems: skin respiratory and hearing Resilience related to IQ , placement, relationship with siblings and stable caregiver Age groups 0-2 20% 3-4 16% 5-10 34% 11-13 17% 14-17 13% increase DNA with set appts Most common recommendations Recs are for enrol with GP 2000 plus rec

All children and young people need: “Safe, stable, nurturing relationships and environment” Parent training MST trauma informed care Nurse family partnership life skills training Built environment: decrease access to guns and alcohol/drugs Poverty education housing inequalities

And just a little more….. We need to support policies that promote permanency for children in long term care Therapeutic potential for foster/CYF and whanau care is greater for children placed at earlier ages Late placement for children who have already attachment and mental health difficulties has limited therapeutic potential (M Tarren Sweeney and A Vetere (eds.) Mental Health service for Vulnerable Children and Young People : Supporting Children who are, or have been, in foster care Routledge, 2014) Ongoing work : breaking down barriers and silos to accessing support for these children and young prople; research and review e.g. Sibling’s attachment adds to emotional resilience and ; keeping the team safe SUPERVISION

Not as straight forward as we first thought